Sep 6, 2022

Providing accessible and effective psychotherapy for those with BPD

Shorter treatment could help bring psychotherapy to a greater number of people living with BPD

A man sits across from a therapist in a brightly lit room
By Ben Gane

Borderline personality disorder (BPD) is one of the most challenging mental illnesses to treat. Characterized by problems handling emotions, difficulty controlling behaviour, and disrupted relationships, BPD is a serious mental disorder that can cause suicidal ideation and behaviour. Dialectical behaviour therapy (DBT) has been proven to help, but it is resource-heavy and often a long process, which can create barriers to access. Dr. Shelley McMain and her team are exploring if briefer DBT can relieve the symptoms of BPD and provide lasting improvement while increasing the accessibility of care.

Dr. Shelley McMain
Dr. Shelley McMain

What is dialectical behavior therapy?

SM: Dialectical behavior therapy (DBT) is a form of psychotherapy that integrates mindfulness and acceptance-based strategies. DBT focuses on helping people regulate their emotions, tolerate stress, and improve their relationships and overall functioning. It has been shown to be an especially helpful for people with borderline personality disorder (BPD) and others exhibiting severe problems with emotion dysregulation. Research demonstrating the usefulness of DBT has made it one of the most commonly recommended treatments for BPD.

 What motivated this research?

SM: There is a great deal of work to be done to increase access to psychotherapy for patients who need it. Standard DBT treatment usually takes one year and is expensive to provide as it involves an intensive combination of weekly individual and group therapy sessions, coaching over the phone, and group consultation sessions for the DBT therapists themselves. Its length means it is involved, expensive, and difficult to access.

One approach to making therapy for BPD more accessible is to shorten the length of treatment. The main goal of our study was to look at whether a shorter 6-month dose of DBT would work as well as the standard full year of treatment for chronically suicidal patients diagnosed with BPD and if it would be a cost-effective treatment option for our healthcare system.

 What was the most important finding of this study, in your opinion?

SM: Importantly, this study found that 6 months of DBT was no less beneficial than 12 months of DBT. Patients experienced an improvement in their symptoms over the course of two years regardless of whether they received 6 months or 12 months of DBT. Unexpectedly, we also found that patients who received a shorter dose of treatment improved at a faster rate for certain symptoms.

How does this change treatment for borderline personality disorder in the future?

SM: These findings indicate that briefer psychotherapy for patients with complex presentations can be beneficial. There is a common belief that people with BPD require longer, intensive treatment; our findings challenge this perspective. Greater investment in briefer treatments could be a key strategy to increasing access to effective care for people with BPD.

Any next steps?

SM: Although on average 6 months of DBT was not worse than 12 months, individuals responded in different ways to shorter and longer DBT treatment services.  Our next step is to identify whether specific patients may respond better to shorter or longer therapy. Understanding how patients differ in their responses to these two briefer and longer doses of treatment can help us understand how to match individuals to the therapy dose that will have the best outcomes.  

What is the major take home message for the public?

SM: Longer therapy isn’t necessarily better for every individual with BPD! Therapists and healthcare providers should consider the benefits of briefer approaches to treatment for individuals with severe personality disorders like BPD.

ImPACT logo: Psychiatry articles that change treatment

Acknowledgements

Agencies that supported this research include: Canadian Institute of Health Research (CIHR).

ImPACT Committee includes Krista Lanctôt, Alastair Flint, Meng-Chuan Lai and Simone Vigod

McMain SF, Chapman AL, Kuo JR, Dixon-Gordon KL, Guimond TH, Labrish C, Isaranuwatchai W, Streiner DL. The Effectiveness of 6 versus 12 Months of Dialectical Behavior Therapy for Borderline Personality Disorder: A Noninferiority Randomized Clinical Trial. Psychother Psychosom. 2022 Jun 23:1-16. doi: 10.1159/000525102.